Peripheral Anterior Synechiae

Peripheral Anterior Synechiae 

Clinical features:

  • The peripheral iris attaches anteriorly in the anterior chamber angle.
  • Attachment may extend to anterior portion of ciliary body, scleral spur, corneoscleral trabecular meshwork, Schwalbe's line or to cornea.
  • May be localized or broad and extensive.
  • May cause acute-angle closure glaucoma.
  • Secondary shallowing of the anterior chamber and resulting blockage of aqueous outflow via the trabecular meshwork may cause chronic angle-closure glaucoma. 
  • Sometimes is confused with a normal prominent uveal meshwork (i.e. iris processes). 
  • May develop in association with a number of ocular conditions such as neovascular glaucoma, iris bombé, heterochromic cyclitis, chronic iridocyclitis, pigmentary glaucoma, post-laser trabeculoplasty, post-scleral buckling procedure, post-trabeculectomy, ciliary body tumors, and essential iris atrophy. 
  • Gonioscopic examination demonstrates a uniform and solid iris segment blocking the view of angle structure.

Management:

  • Peripheral laser iridotomy is recommended for patients with documented acute or subacute angle-closure glaucoma attack, persistent increase IOP and PAS without underlying secondary causes.
  • Other treatment modalities include anti-glaucoma medications, laser iridoplasty, anterior chamber paracentesis, surgical iridectomy, synechialysis, and filtration surgery.